Baltimore, MD—Intensive blood-pressure (BP) treatment appears to reduce cardiovascular events in type 2 diabetes (T2D) patients, while also lowering their all-cause mortality rates, according to a new study.

A report in Hypertension notes that T2D patients who received intensive treatment to keep their blood pressure levels at 130/80 mmHg or below had fewer diabetes complications, as well as lower heart attack and stroke rates. These patients also had lower overall risk of dying from any cause.

Notable in the study was that benefits occurred even in patients whose BP was not significantly elevated and/or those who were not at particularly high risk for cardiovascular disease (CVD) events.

Johns Hopkins School of Medicine–led researchers point out that the optimal blood BP goal in T2D patients remains controversial, which led them to examine whether benefits and risks of intensified antihypertensive therapy in diabetes mellitus are influenced by either baseline BP or CVD risk.

To do that, the study team focused on nearly 11,000 diabetes patients at moderate-to-high risk in the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation).

Results indicate that, over 4.3 years of follow-up, treatment with perindopril-indapamide versus placebo reduced mortality and major vascular events, whether macrovascular or microvascular.

Researchers found no evidence of differences in the effects related to:
• Baseline systolic BP—evaluated down to <120 mmHg; P for heterogeneity, .85;
• Diastolic BP—evaluated down to <70 mm Hg; P = .49); or
• Whether 10-year CVD risk had been calculated as less than or greater than 20%

The study notes that the effects of randomized treatment on discontinuation of treatment because of cough or hypotension/dizziness were also statistically consistent across subgroups defined by baseline BP and CVD risk.

“Adults with diabetes mellitus appear to benefit from more intensive BP treatment even at levels of BP and CVD risk that some guidelines do not currently recommend for intervention,” the authors write. The findings shed new light on optimal blood-pressure targets and could help reconcile conflicting guidelines for the treatment for hypertension in people with type 2 diabetes—the more common form of the disease affecting more than 420 million people worldwide.”

The study’s senior investigator, J. Bill McEvoy, MB, BCH, MHS, professor of preventive cardiology at the National University of Ireland, Galway Campus, and the Irish National Institute for Preventive Cardiology, added, “Our findings demonstrate a benefit of more intensive therapy aiming for blood pressure thresholds at 130/80 or below and should help resolve some ongoing confusion over optimal blood pressure targets for people with diabetes.”

McEvoy suggested that patients with BP levels above 130/80 on two consecutive checks should be advised to ask their physicians about treatment to lower hypertension levels.

The 2017 American College of Cardiology/American Heart Association blood pressure guidelines recommend initiating antihypertensive treatment at a blood pressure of 130/80 mmHg or higher for adults with diabetes and hypertension, with a goal to reduce BP to below 130/80 mmHg.

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